16 Drug prescribing in older patients with reduced kidney function—how do we fair?

Résumé fourni par la source

Abstract Background The population is getting older and projected to rise over the coming decades. Chronic Kidney Disease (CKD) will also become more prevalent as CKD is more prevalent in older people. Patients with CKD tends to have multiple comorbidities, and this is compounded by ageing. Both these factors increase their risk of polypharmacy due to altered pharmacokinetics and pharmacodynamics. We aim to identify the rate of polypharmacy (≥5 medications) and hyper-polypharmacy (≥10 medications) in patient age ≥ 75 with reduced kidney function and to identify prescribing of medications requiring renal dose adjustment. Methods A cross-sectional audit was performed across 3 days in August 2022. Patients age ≥ 75 admitted were identified using PIMS. We reviewed their Kardex for medications prescribed, EVOLVE for kidney function parameter and medical notes for indications for medication prescribed and need for sick day rule. Results N = 74 patients included with a mean age 82.9 years, 39/74(52.7%) male and 51/74(68.9%) of weights recorded. Mean number of medications prescribed was 11.4. The rate of polypharmacy was 72/74(97.3%) while hyper-polypharmacy was 43/74(58.1%). 36/74(48.6%) have eGFR<60 mL/min/1.73m2. In this cohort with reduced kidney function, the rate of polypharmacy was 35/36(97.2%) while hyper-polypharmacy was 22/36(61.1%). 27/74(36.5%) were on DOACs. Of those on apixaban, 4/19(21.1%) incorrectly prescribed while 3/19(15.8%) may be on the wrong dose, due to missing weight. Other medications include sitagliptin; 1/2 were over-dosed, alendronate; 1/2 prescribed 35 mg weekly with end-stage kidney disease and nitrofurantoin; 1/1 over-dosed. Sick day rule is applicable in 10/74(13.5%); 9/10(90%) complied. Conclusion The prevalence of polypharmacy and hyper-polypharmacy among inpatient population age ≥ 75 is high and hyper-polypharmacy is more prevalent with reduced kidney function. There was incomplete and inaccurate prescribing of medications, weight and indications on Kardexes. There needs to be improved awareness regarding prescribing in an already vulnerable population with multiple co-existing chronic disease.

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